ObjectiveTo provide the best evidence for an old diabetic patient who combined with frailty syndrome with the goal of glycemic control, treatment strategy and their prognosis. MethodsPubMed, MEDLINE (Ovid), EMbase, The Cochrane Library (Issue 11, 2015) and CNKI were searched from their inception to Nov. 2015, to collect evidence about the management of glycemic control. Evidences were analyzed by the way of evidenced-based criterions. ResultsOne clinical guideline, one meta-analysis, three RCTs, seven cohort studies and four case-control studies were included. Evidence showed that compared with patient uncombined with frailty, old diabetic patients with frailty had a higher prevalence of dementia, cardiovascular diseases and death; Aggressive glycemic control could not reduce the prevalence of cardiovascular events and the risk of death, while it could increase the risk of falling. Glycemic control was more comprehensive which would be taken frailty into consideration. Diet rich in protein (especially leucine), resistance exercise and reasonable medications based on comprehensive geriatric assessment were proved benefit for the old diabetic patient. ConclusionThe incidence of cardiovascular events, hypoglycemia and mortality are increased in this old diabetic patient who combined with frailty. Maintaining HbA1c around 7.5% is reasonable and diet with enough calorie and rich in protein (especially leucine), resistance exercises should be recommended for the person.
ObjectivesTo systematically review the epidemiological characteristics of frailty in Chinese elderly population.MethodsPubMed, EMbase, Web of Science, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on the epidemiological characteristics of frailty in China from January, 1978 to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using OpenMetaanalyst software.ResultsA total of 29 studies, involving 64 306 patients were included. The results of meta-analysis showed that: the prevalence of frailty in Chinese community was 12.8% (95%CI 0.105 to 0.152), in Chinese hospital was 22.6% (95%CI 0.130 to 0.270), and in nursing home was 44.3% (95% CI 0.222 to 0.664). In the subgroup analysis by gender: male prevalence in community was 9.2% (95%CI 0.074 to 0.110), female was 12.9% (95%CI 0.100 to 0.157). Prevalence of male in hospital was 23.3% (95%CI 0.124 to 0.342), Prevalence of female was 17.9% (95%CI 0.122 to 0.237). In the subgroup analysis by region: the prevalence of frailty in north China was 13.4% (95%CI 0.093 to 0.175), in east China was 13.6% (95%CI 0.083 to 0.189), and in Taiwan province and HongKong was 9.8% (95% CI 0.078 to 0.199). In the subgroup analysis by age: the prevalence of frailty among the elderly aged 65 to 74 was 12.2% (95%CI 0.037 to 0.206), and 33.2% (95%CI 0.136 to 0.527) among the elderly aged 75 to 84, and 46.8% (95%CI 0.117 to 0.820) among the elderly aged above 85. For investigation based on time periods, the prevalence of frailty was 9.1% (95%CI 0.078 to 0.104) from 2003 to 2010, and 14.4% (95%CI 0.111 to 0.177) from 2011 to 2018.ConclusionsThe prevalence of frailty in China is high. Economic underdevelopment is higher in more developed regions. The prevalence in hospital population is higher than that in community population. The prevalence of female in community and rural is higher than male. The higher ages has higher prevalence. The prevalence of frailty from 2011 to 2018 is higher than from 2003 to 2010. As no uniform screening tools exist, the results of this study requires further validations by high quality research.
Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.
ObjectivesTo analyze and track the hotspots and frontiers of the field of frailty by analyzing the related research published by SCI-journals in recent decade.MethodsData of publications from 2010 to 2019 were retrieved from the Web of Science Core Collection database. CiteSpace was used to analyze the hotspots and frontiers of frailty research from high-impact countries/regions, institutions, authors, high-frequency keywords and burst terms.ResultsA total of 12 768 publications were identified. The United States was the leading country for publications. Research hotspots focused on adverse health outcomes associated with frailty, interventions, and frailty in elderly patients and females. Besides, frailty assessment and screening, cohort study, meta-analysis and cognitive impairment were the frontier fields.ConclusionsAdverse health outcomes associated with frailty, interventions, and frailty in elderly patients and females are the hotspots and frontiers of frailty research.
ObjectiveTo systematically review the relationship between frailty and risk of orthostatic hypotension.MethodsPubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the association between frailty and orthostatic hypotension from inception to July 7th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsFive cross-sectional studies involving 8 671 patients were included. The results of meta-analysis showed that prefrailty (OR=1.04, 95%CI 0.99 to 1.09, P=0.11) and frailty (OR=1.02, 95%CI=0.92 to 1.13, P=0.70) were not associated with orthostatic hypotension. The results of subgroup analysis showed that differences of sample size (<500 or ≥500), using different frailty assessment tools (Fried scale, clinical frailty scale, and frailty index), different regions (Europe, Asia, and America) and different sources of studied subjects (hospitals and communities), the risk of orthostatic hypotension were not increased with frailty.ConclusionsCurrent evidence shows that frailty does not increase the risk of orthostatic hypotension. Due to limited quality and quantity of included studies, the above conclusions are needed to be validated by more high-quality studies.
ObjectiveTo systematically review the dose-response relationship between body mass index (BMI) and all-cause mortality in the elderly with frailty.MethodsPubMed, EMbase, Web of Science, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect cohort studies on the association of BMI and mortality in frail adults from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies; Stata 15.0 software was then used to analyze the dose-response analysis of BMI and mortality by restricted cubic spline function and generalized least squares method.ResultsA total of 4 cohort studies involving 12 861 frail adults were included. Meta-analysis results showed that compared with normal BMI, the frail elderly who were overweight (HR=0.80, 95%CI 0.74 to 0.88, P<0.001) and obese (HR=0.89, 95%CI 0.79 to 1.00, P=0.047) had lower all-cause mortality. The results of dose-response meta-analysis showed that there was a non-linear relationship between BMI and all-cause mortality in the elderly with frailty (P value for nonlinearity was 0.035), for which the elderly with frailty had a BMI nadir of 27.5-31.9 kg/m2. For linear trends, and when BMI was less than 27.5 kg/m2, the risk of all-cause death was reduced by 4% for every 1 kg/m2 increase in BMI (RR=0.96, 95%CI 0.90 to 1.03, P=0.320), when BMI was greater than 27.5 kg/m2, the risk of all-cause death increased by 4% for every 1 kg/m2 increase in BMI (RR=1.04, 95%CI 1.03 to 1.05, P<0.001).ConclusionsThere is a paradox of obesity and a significant nonlinear relationship between BMI and all-cause mortality in the frailty elderly, with the lowest all-cause mortality in the frailty elderly at BMI 27.5-31.9 kg/m2. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusions.
ObjectiveTo systematically evaluate the prevalence of diabetes in the elderly with frailty.MethodsPubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on the prevalence of diabetes in the elderly with frailty from inception to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed by using Stata 15.0 software.ResultsA total of 21 cross-sectional studies involving 22 403 subjects were included. The pooled prevalence of diabetes in the elderly with frailty was 34% (95%CI 26% to 43%). Subgroup analysis showed that the prevalence of diabetes in patients with frailty in Asia and South America was higher than those in Europe and North America. The prevalence of diabetes in patients with frailty using physical frailty measures to evaluate frailty was higher than using multidimensional frailty measures. The prevalence of diabetes in patients with frailty in outpatient and hospital were higher than those in the community.ConclusionsCurrent evidence suggests that the prevalence of diabetes is high in the elderly with frailty.
Objective To systematically review the influence of frailty on the prognosis of non-cardiovascular surgery heart failure (HF) patients and to provide references for its prevention and management. Methods CNKI, VIP, CBM, WanFang Data, PubMed, EMbase, Web of Science, and The Cochrane Library were searched to collect cohort studies on the prognosis of non-cardiovascular surgery HF patients with frailty from inception to November 1st, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software. Results A total of 20 studies involving 11 127 patients were included. The results of meta-analysis showed that frailty increased the risk of all-cause mortality (HR=1.72, 95%CI 1.61 to 1.84, P<0.000 01), hospitalization (HR=2.06, 95%CI 1.26 to 3.37, P=0.004), and combined endpoint (HR=1.59, 95%CI 1.37 to 1.84, P<0.000 01) in non-cardiovascular surgery HF patients. Conclusion Current evidence shows that frailty can increase the risk of all-cause mortality, hospitalization, and combined endpoints in non-cardiovascular surgery HF patients. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the effect of different nutrient interventions on the physical function of elderly people with frailty through network meta-analysis. Methods The PubMed, Cochrane Library, EMbase and Web of Science were electronically searched to collect randomized controlled trials of different nutrient interventions on physical function of the elderly with frailty, from database inception to June 30, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using ADDIS 1.16.8, GeMTC 14.3, and Stata 15.0 software. Results A total of 13 studies involving 1 144 patients were included. There was no statistically significant difference in handgrip strength, time up to go test, gait speed, and short physical performance battery (SPPB) among different nutrient interventions. Significant differences were not found in vitamin D+ whey protein (VDWP) vs. placebo and Leu vs. placebo in handgrip strength, or VDWP vs. placebo in SPPB. The probability ranking diagram showed that the most effective of handgrip strength, time up to go test, gait speed, and SPPB were milk protein concentrate (MPC80), L-carnitime (L-Car), leucine (Leu), and MPC80, respectively. Conclusion The current evidence suggests that nutritional intervention did not significantly improve physical function in the frail elderly. MPC80, Leu, L-Car, and VDVEWP may play a role in improving the physical function of frail elderly people. Nutritional support programs that increase the above nutrients, combined with exercise training may become a better way to improve the physical function of frail elderly.
Objective To evaluate the effect of frailty on postoperative complications in elderly patients with esophageal cancer.Methods We enrolled the patients aged≥65 years and with esophageal cancer who underwent surgical treatment in Shanghai Chest Hospital in 2021. The modified frailty index (mFI) was calculated and the patients were divided into a non-frailty group and a frailty group. The primary outcomes were the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula and chylothorax complications. Secondary outcomes were the time of extubation, the rate of unplanned re-intubation, the length of ICU stay, hospital stay, rate of readmission within 30 days after discharge and the mortality within 30 days after operation.Results Finally 607 patients were collected. There were 273 patients in the non-frailty group and 334 patients in the frailty group. The non-frailty group had lower rates of complications including pulmonary infection (5.5% vs. 13.5%), arrhythmia (3.7% vs. 9.3%), anastomotic fistula (2.9% vs. 7.5%), and shorter ICU stay [2.0 (0.0, 4.0) d vs. 4.0 (1.0, 6.0) d] and in-hospital stay [11.5 (9.5, 13.0) d vs. 13.0 (11.0, 18.0) d],lower rates of the readmission within 30 days (2.9% vs. 6.6%) and the mortality within 30 days (0.4% vs. 1.2%) compared with the frailty group (P<0.05).Conclusion Frail elderly patients with esophageal cancer have higher rates of postoperative complications. mFI can be used as an objective index to identify high-risk elderly patients with esophageal cancer.